Dr. Susan Sharma: Thank you for joining us at Insidermedicine's In Depth analysis of the OPALS Study, published in this week's issue of the Canadian Medical Association Journal. I'm Dr. Susan Sharma.
It does not appear to be beneficial and may even be harmful for paramedics to perform advanced life support techniques on trauma patients, rather than waiting for these techniques to be performed when the patients reaches the hospital.
According to research published today in the Canadian Medical Association Journal, over half a million Americans experience severe trauma, defined as an injury causing death or loss of a limb every year.
If you are the first person to arrive at an emergency medical scene, St. John Ambulance recommends that you take the following steps. Take control of the situation. This involves, assessing the scene for immediate risks, like impending explosions, calling out for bystanders to help, assessing casualties and calling for medical help.
Call 911 immediately and always let the dispatcher hang up the phone first. Getting experienced emergency personnel to the scene is crucial. Perform a primary survey, which means you need to assess for life-threatening injuries and give life-saving first aid when necessary. When you're assessing for life-threatening injuries, first do the ABCs. Assess the patient's airway, breathing, and circulation by finding a pulse. If qualified to do so, administer CPR, if necessary.
If you are the second to arrive at an accident scene and a first aider has already taken control of the scene, ensure steps 1-3 have taken place. Then, ask the person in charge if you can be of any assistance.
In many trauma centers, paramedics perform advanced procedures as soon as they reach a severely injured patient, such as inserting an airway tube down the throat and establishing IV access. Some question the value of these practices, arguing that they may actually delay definitive treatment.
In the present study, researchers from 17 Canadian hospitals compared the effect of paramedics using advanced techniques, such as airway tube insertion and IV placement, in 1500 trauma patients with the effects of using more basic life support techniques, such as using oxygen bags and dressings in about another 1400 patients before they reached the hospital.
While nearly four out of five patients survived their trauma, advanced techniques did not improve survival rates. In fact, placing a tube in the airway of a patient appeared to raise the risk of death. And the use of advanced techniques in general, appeared to raise the risk of death in those with severe head injuries.
We had a chance to speak with Dr. Ian Stiell, the main medial researcher behind the study, about the results and the implications of the study.
Dr. Ian Stiell: The ability to intubate or give IV fluids really didn't make any difference for major trauma patients, so people who've been very badly injured in urban setting. The second finding is that, in fact, for the most severely injured patients who might have caused the worst outcome, so that's of some concern.
One would hope that the principle that the EMS services are following is to get the patient to the hospital as fast as manageable and it should be ideally bypassing small hospitals and heading quickly to a major trauma center.
Dr. Susan Sharma: In a related editorial, Dr. Davis, an expert in Emergency Medicine from San Diego, cautions against concluding that advanced life support, in general, or placing an airway into a patient before they reach the hospital, in particular, is harmful in all patients. Instead, he recommends attempting to better understand the mechanisms that explain these associations and work towards optimizing pre-hospital support.
Given the results of this study, the concept of advanced life support by paramedics in patients who have suffered severe trauma may need to be reevaluated. If you witness a severe trauma, you should immediately call 911 and be prepared to assist as needed.
For Insidermedicine's In Depth analysis of the OPALS Study, published in this week's issue of the CMAJ, I'm Dr. Susan Sharma.
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